Business Services Representative

The Business Service Representative works under the direction of the Business Service Manager. Job duties include review of services provided to determine accuracy; posting all charges, adjustments, and submitting claims to all parties responsible for payment; processing claim for payment; posting payments to the appropriate accounts; reconciling denials, verifying coverage; updating insurance profiles; follow-up of unpaid claims; assists with maintenance of data files; and, other duties, as assigned .

• Supports and implements the organization's vision, mission and value.
• Determines priorities and method of completing daily workload to insure that all responsibilities are carried out in a timely manner.
• Performs all job functions in a professional and courteous manner. This includes answering all general phone calls timely. Provide excellent customer service to internal and external customers by being responsive to all inquiries in a timely manner.
• Fosters and promotes a culture of service excellence and accountability.
• Reviews assigned pending charges to validate accuracy of responsible party, charges (CPT), and diagnosis (ICD)
• Review electronic health and dental systems for charge and diagnosis verification. Communicates electronically with provider of service for missing charges and/or clarity of diagnosis
• Posts all transactions to include charges, adjustments, insurance and patient payments and reconciles postings to the General Ledger. Resolves credit balances via adjustments and/or refund
• Receives, reviews, processes, and submits QueensCare Grant hospital and/or physician claims for payment in accordance to established guidelines.
• Reviews and edits claims listed in the electronic insurance batch system to insure accuracy and transmits same to the insurance carrier(s) for payment.
• Reviews payment denials, underpayments, and payment take backs for appropriateness and produce resolution by resubmission to the insurance carrier, patient billing, or appropriate adjustment.
• Verifies patents coverage via electronic media and document review prior to billing and based on eligibility denial. Update patient insurance profile and claims as needed.
• Reviews patient accounts post -payment and bills secondary insurance carrier when applicable.
• Performs follow-up of unpaid claims via electronic media or telephone.
• Prepares and submits requests for payment statement for patient responsibly. Assigns unpaid accounts to Bad Debt when collection efforts are exhausted.
• Assists Business Service Management with maintenance of data files necessary to perform tasks.
• Performs as a resource with other departments as it relates to issues of insurance coverage and eligibility.
• Complies with organizational policies and procedures.
• Performs all other duties as assigned.

• High School Diploma or equivalency and three years of medical billing experience required.
• Must demonstrate a clear understanding of medical terminology, Current Procedural Terminology (CPT) and International Classification of Disease (ICD) coding.
• Working knowledge of billing for a multi-discipline practice and general computer systems required.

• Demonstrates ability and flexibility to work in other areas of the organization as needed.
• Performs work in adherence to company's policies and procedures.
• Demonstrate required knowledge, skills, education for job functions.